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Next generation JAK-inhibition strategies
It has been just over a decade since the approval of tofacitinib (JAK1/JAK3-inhibitor) by the US FDA for the treatment of rheumatoid arthritis. Since then, baricitinib (JAK1/JAK2-i), filgotinib and upadacitinib (both selectively targeting JAK1) also have been licensed for the treatment of rheumatoid arthritis. As there are many more JAK-inhibitors evaluated in clinical trials currently, how do you stand out?
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MTX Toxicity in Older CKD Patients
You know this; you've taught this; but here's a good study documenting a higher risk of methotrexate toxicity when used in the setting of older patients with chronic kidney disease.
Yesterday's JAMA published a higher 90-day risk of serious adverse events in older adults with CKD taking low-dose methotrexate, compared to hydroxychloroquine.
What do you think of the concept of "dysuricemia" - the concept that both hyperuricemia and hypouricemia influence diseases. “The lower, the better” is incorrect; the ideal is to maintain normouricemia, or optimal SU level, to reduce the urate burden https://t.co/Vi9htWTNwr https://t.co/fsx9Oq08Ak
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Dr. John Cush RheumNow ( View Tweet)
Reconsidering Steroids
Not one of us in rheumatology hasn’t prescribed steroids, but we need to reconsider how much/how often we use them. In almost every disease state we treat, we are seeing progression towards lesser and shorter courses .
https://t.co/VRlCeNXyKR https://t.co/k5Uy7IHr3h
Dr. John Cush RheumNow ( View Tweet)
TNFi and RA-ILD – The Pendulum Swings Again
Tumour necrosis factor inhibitors (TNFi) revolutionised the treatment of rheumatoid arthritis. They heralded the wave of advanced therapies, which has transformed the treatment landscape in rheumatic disease.
https://t.co/zBwJKyDihL https://t.co/uCLnmaLC9j
Dr. John Cush RheumNow ( View Tweet)
Single center obs. study 74 RA-ILD pts Rx w/ antifibrotics (40 nintedanib; 34 pirfenidone); F/U 89 wks, had signif improvement in FVC estimated decline after antifibrotics (-0.3% w/ vs -6.2% w/o). 35% died, 4 lung transplants. 55% AEs, 46% D/C Rx https://t.co/s6O5uU3z2i
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#ACR23 Abst#1629 from FORWARD registry showed RA pts (n667) with LONG COVID (15%) had worse RA pre-COVID and post-infx, and had worse COVID (more ABx & hospitalization). RA-long Covid pts had 3fold more fibromyalgia (13 vs 41%) https://t.co/VFNAnSxNzN https://t.co/WLqmdM3Nn2
Dr. John Cush RheumNow ( View Tweet)
Watch: No Increased Mortality in Patients with RA Receiving Checkpoint Inhibitors
Dr. Mike Putman discusses abstract 1071 with Dr. Madeline O'Sullivan at the 2023 ACR Convergence meeting in San Diego, CA.
https://t.co/YdIlhLf5gh https://t.co/6dfWHakboh
Dr. John Cush RheumNow ( View Tweet)
ACR Daily Recap - MONDAY
Panelists: Drs. Kathryn Dao, Michael Putman and Eric Dein
Moderator: Dr. Jack Cush
https://t.co/b1k1gsHI2z https://t.co/BWu7GXFxhj
Dr. John Cush RheumNow ( View Tweet)
IgG4 disease- the WInS withdrawal study results
https://t.co/rg0YJ0LlZM https://t.co/L6SzcD7QlJ
Dr. John Cush RheumNow ( View Tweet)
Theres a ustekinumab biosimilar, CT-P43 - In a multinational, phase III study in 509 plaque psoriasis pts, CT-P43 was equivalent to the originator, Stelara, with week 16 PASI75 scores of 78% vs 76%, and continued efficacy out to week 40 https://t.co/dEImEp8l90 https://t.co/UoqGgaad8H
Dr. John Cush RheumNow ( View Tweet)
FDA issued a safety alert for BCMA- or CD19- Autologous CAR-T cell Immunotherapies; they've received reports & are investigating Risk of T-cell Malignancy (CAR-positive lymphoma) occuring in several products w/in this class (most for Cancer use) https://t.co/RpBhcGarGy https://t.co/mDuXmVW4Fz
Dr. John Cush RheumNow ( View Tweet)
Rheumatoid Arthritis Topic Podcast
https://t.co/ClEuz2bVzA https://t.co/19jZhSt3Dc
Dr. John Cush RheumNow ( View Tweet)
Does GnRHa Reduce Premature Ovarian Insufficiency in SLE Patients on Cyclophosphamide?
https://t.co/GVk2KLoGYq https://t.co/Hv9Bcn8cLg
Dr. John Cush RheumNow ( View Tweet)
Why are older RA patients getting mistreated?
Most rheums would say that every RA patient should be started on a DMARD. So I'm shocked that, in a US Medicare 20% sample dataset b/w 2008-17, less than 30% of new RA patients aged 66+ have a DMARD initiated.
https://t.co/VFp3oz8wGK https://t.co/60Jn6ShmDs
Dr. John Cush RheumNow ( View Tweet)
Do We Stop or Continue Treatment?
Remission had been a dream, an elusive concept. But then, with the introduction of biologics, conventional synthetic and targeted synthetic DMARDS, patients are able to live longer and with a better quality of life.
https://t.co/qSgfuDvAQb https://t.co/eUzIaC35tl
Dr. John Cush RheumNow ( View Tweet)
WATCH: TMP SMX Prophylaxis in GPA
https://t.co/JtIjgxwrCf https://t.co/Tmzdu00oyH
Dr. John Cush RheumNow ( View Tweet)
The SMART Study: Split Dose Oral Methotrexate
Dr. Jack Cush discusses abstract 1583 presented at the 2023 ACR Convergence meeting in San Diego.
https://t.co/Blg4EUe5rX https://t.co/0svgLAZ1as
Dr. John Cush RheumNow ( View Tweet)
An Interview with Kevin Winthrop: Three Questions About COVID 19
Drs. Jack Cush and Kevin Winthrop discuss COVID 19 at 2023 ACR Convergence in San Diego, CA.
https://t.co/UL8q356G3i https://t.co/wWsEHz9obA
Dr. John Cush RheumNow ( View Tweet)
JAKi and TYK2i: What/when to use?
You can see that the JAKi/TYK2i have both approved or potential seropositive and seronegative indications. There are also improvements in PsO for the class and studies in CTDs. It is difficult to know which to choose
https://t.co/uid38oFBXP https://t.co/gLJfJNi2Jh
Dr. John Cush RheumNow ( View Tweet)